Depression and anxiety in dry eye disease: a systematic review and meta-analysis

AimTo evaluate the association of dry eye disease (DED) with depression and anxiety.Patients and methodsWe conducted a systematic review and meta-analysis of studies that reported the prevalence, incidence and/or severity grading of depression and/or anxiety in DED patients and healthy controls. We searched MEDLINE, EMBASE, PsycINFO, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform for relevant studies.ResultsTwenty-two eligible studies consisted of 2 980 026 patients were analyzed. DED was associated with an increased prevalence of depression (summary odds ratio (OR)=2.92, 95% CI: 2.13-4.01, P<0.00001) and anxiety (OR=2.80, 95% CI: 2.61-3.02, P<0.00001). The depression score (standardized mean difference (SMD)=0.81, 95% CI: 0.48-1.15, P<0.00001) and anxiety score (SMD=0.37, 95% CI: 0.10-0.64, P=0.007) were higher in DED patients than in controls. Subgroup analyses revealed that the prevalence and severity of depression are greatest in primary Sjogren's syndrome patients. No study reported the incidence.ConclusionDepression and anxiety are more prevalent in DED patients than in controls. Among patients with DED, those suffering from primary Sjogren's syndrome have higher prevalence and severity of depression.

Prevalence of and risk factors associated with dry eye: the Korea National Health and Nutrition Examination Survey 2010-2011

PURPOSE

To investigate the prevalence of and risk factors associated with dry eye syndrome (DES) in South Korea.

DESIGN

Cross-sectional study.

METHODS

In 2010 and 2011, 11,666 subjects, ranging in age from 19 to 95, were randomly selected as nationally representative participants in the Korea National Health and Nutrition Examination Survey (KNHANES). Subjects were divided into 2 groups: 1 with clinically diagnosed DES and 1 with symptoms of dry eye. We determined the prevalence of and risk factors for dry eyes in a Korean population. Health-related quality of life (HRQoL), measured by the EuroQoL-5 dimension (EQ-5D), was evaluated in patients with dry eyes.

RESULTS

The mean age was 49.9 years. The overall prevalence of diagnosed DES was 8.0% (95% confidence interval [CI], 7.3% to 8.7%), and of dry eye symptoms the prevalence was 14.4% (95% CI, 13.1 to 15.7). Age (adjusted odds ratio [aOR] = 1.8, 1.6), female (aOR = 2.8, 1.9); history of eye surgery (aOR = 2.6, 2.2); stress (aOR = 1.7, 1.6); thyroid disease (aOR = 1.7, 1.5); and high education level (aOR = 1.6, 1.5) were common risk factors in the groups. Subjects who had undergone ptosis, cataract or refractive surgery were more likely to have dry eye than subjects with no history of eye surgery. Means of pain and anxiety dimensions in the EQ-5D and the Euro Quality of Life Visual Analog Scale (EQ-VAS) were significantly higher in the group with diagnosed DES than in the normal group.

CONCLUSIONS

The risk factors were mostly similar in both groups. It is thought there are more patients with DES who have not been diagnosed by doctors. Doctors should identify whether a patient has any risk factors for dry eye. Patients need to be educated about the modifiable factors of DES.

Impact of ocular surface symptoms on quality of life in a United States veterans affairs population

PURPOSE

To evaluate the impact of ocular surface symptoms on quality of life in a veteran population receiving eye care services.

DESIGN

Cross-sectional survey study.

METHODS

setting: Miami Veterans Affairs Medical Center (VAMC). patient population: Patients seen at the eye clinic between June and August 2010 were asked to fill out the Dry Eye Questionnaire 5 (DEQ5) and the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire. main outcome measures: Correlation between ocular surface symptoms and functionality.

RESULTS

Four hundred eighty-nine patients elected to fill out the DEQ5 questionnaire (36% response rate). The mean age of respondents was 66 years (standard deviation 12). Ninety-four percent were male; 62% were white and 37% were black. Using the DEQ5 as a surrogate measure of ocular surface symptoms, 65% of respondents reported at least mild ocular surface symptoms (DEQ5 ≥6) and 27% of them reported severe symptoms (DEQ5 ≥12). Black subjects had a 2-fold increased risk of severe symptoms compared to white subjects (odds ratio 2.06, 95% confidence interval 1.33-3.19). Several medications were associated with a significantly increased risk of severe symptoms, including glaucoma medications (1.7-fold increase), antidepressants (2.3-fold increase), and antihistamines (2.1-fold increase). There was an inverse correlation between DEQ5 and IDEEL scores with regard to ability to perform activities of daily living (n = 391, r = -0.54, P < .001), emotional well-being (n = 386, r = -0.63, P < .001), and the ability to work (n = 205, r = -0.57, P < .001). Fifty percent of patients with severe symptoms had documentation that their symptoms were addressed during the visit.

CONCLUSION

Severe ocular surface symptoms reduce the quality of life of Miami VAMC veterans. Eye care professionals should be vigilant in eliciting ocular surface complaints from their patients.

Comparing the discriminative validity of two generic and one disease-specific health-related quality of life measures in a sample of patients with dry eye

OBJECTIVE

The purpose of this study was to compare the discriminative properties of two generic health-related quality of life (QoL) instruments (SF-36 and EQ-5D) and a newly developed disease-specific patient-reported outcomes instrument (Impact of Dry Eye on Everyday Life (IDEEL)) to distinguish between different levels of dry eye severity.

METHODS

Assessment of 210 people: 130 with non-Sjogren's Keratoconjunctivitis Sicca (non-SS KCS), 32 with Sjögren's Syndrome (SS) and 48 controls; comparison of SF-36, EQ-5D, and IDEEL age-adjusted data by dry eye severity levels. Severity was assessed based on diagnosis (non-SS KCS, SS, control), patient-report (none, very mild, mild, moderate, severe, extremely severe) and clinician-report (none, mild, moderate, severe).

RESULTS

Discriminative validity results were consistent for all instruments. Significant differences between severity levels were found with most SF-36 scales (P < 0.05), all EQ-5D scales (P < 0.05), and all IDEEL scales (P < 0.0001), except for Treatment Satisfaction. IDEEL scales consistently outperformed the generic QoL measures regardless of the severity criterion used. Most SF-36 scales outperformed the EQ-5D QoL scale, but the EQ-5D visual analog scale outperformed the SF-36 scales, except for General Health Perceptions.

CONCLUSIONS

The disease-specific IDEEL scales are better able to discriminate between severity levels than the majority of the generic QoL scales. Preliminary evidence demonstrates that the IDEEL will be sensitive to QoL changes over time, although further testing in controlled longitudinal studies is needed.

Associations between subjective happiness and dry eye disease: a new perspective from the Osaka study

Importance

Dry eye disease has become an important health problem. A lack of concordance between self-reported symptoms and the outcome of dry eye examinations has raised questions about dry eye disease.

Objective

To explore the association between subjective happiness and objective and subjective symptoms of dry eye disease.

Design

The study adopted a cross-sectional design.

Setting

All the employees of a company in Osaka, Japan.

Participants

672 Japanese office workers using Visual Display Terminals (age range: 26–64 years).

Methods

The dry eye measurement tools included the Schirmer test, conjunctivocorneal staining, the tear film break-up time, as well as the administration of a dry eye symptoms questionnaire. Happiness was measured by the Subjective Happiness Scale.

Main Outcome Measures

Dry eye examination parameters, dry eye symptoms questionnaires, and the Subjective Happiness Scale score.

Results

Of the 672 workers, 561 (83.5%) completed the questionnaires and examinations. The mean Subjective Happiness Scale score was 4.91 (SD = 1.01). This score was inversely correlated with the dry eye symptom score (r = -0.188, p < 0.001), but was not associated with objective findings which include conjunctivocorneal staining, low Schirmer test score, or low tear film break-up time. The level of subjective happiness was the lowest in the group without objective results, but reported subjective symptoms of dry eyes (p < 0.05).

Conclusions and Relevance

There is evidence of the relationship between subjective happiness and self-reported symptoms of dry eyes. Findings of this study revealed a new perspective on dry eye disease, including the potential for innovative treatments of a specific population with dry eye disease.

The potential role of neuropathic mechanisms in dry eye syndromes

Dry eye syndromes can involve both nociceptive and neuropathic symptoms. Nociceptive symptoms are the normal physiological responses to noxious stimuli. Neuropathic symptoms are caused by a lesion or disease of the somatosensory nervous system and can be the result of hypersensitisation of peripheral or central corneal and conjunctival somatosensory nerves. For example, inflammation could induce neuroplastic peripheral sensitisation of the ocular surface or lid wiper and exacerbate nociceptive symptoms. Neuropathic symptoms may explain the incommensurate relation between signs and symptoms in some dry eye syndromes although absence of signs of a dry eye syndrome may also be a consequence of inappropriate methods used when examining for them. Involvement of neuropathic mechanisms may also help explain dry eye symptoms which occur in association with reduced corneal sensitivity. This review includes a discussion of the potential for ocular symptoms involving neuropathic mechanisms to contribute to psychosocial problems such as depression, stress, anxiety and sleep disorders as well as for these types of psychosocial problems to contribute to neuropathic mechanisms and dry eye syndromes. Failure to consider the possibility that neuropathic mechanisms can contribute to dry eye syndromes may reduce accuracy of diagnosis and the suitability of treatment provided. Dry eye symptoms in the absence of commensurate evidence of tear dysfunction, and unsatisfactory response to tear dysfunction therapies should prompt consideration of neuropathic mechanisms being involved. Symptoms which persist after local anaesthetic instillation are more likely to be neuropathic in origin. Reducing inflammation may help limit any associated neuroplastic hypersensitivity.

Symptoms of ocular irritation in patients diagnosed with dry eye

PURPOSE

The purpose of this study was to develop a pilot survey to evaluate ocular irritation symptom frequency, severity, and impact on daily activity in patients previously diagnosed with dry eye.

METHODS

Forty-five patients previously diagnosed with dry eye (ICD-9 code 375.15) completed the 17-item symptom survey. Analog-scale response questions concerning the frequency, severity, and effect on daily activity were asked for the following symptoms: dryness, scratchiness and soreness, burning and stinging, light sensitivity, blurry vision, and ocular itching.

RESULTS

Dryness and soreness were the most frequently reported symptoms of ocular irritation. Although the occurrence of symptoms of ocular irritation was reported as frequent by patients diagnosed with dry eye, the symptoms had minimal to moderate impact on daily activity.

CONCLUSIONS

Patient expression of the symptoms of dryness and soreness at more frequent and/or more severe levels may lend more validity to a diagnosis of dry eye.

Ocular Discomfort and Quality of Life Among Patients in the Dry Eye Assessment and Management Study

PURPOSE

To assess the association of severity of ocular discomfort with measures of quality of life among patients with moderate to severe dry eye disease (DED).

METHODS

This is a prospective, observational, cohort study within a randomized clinical trial. Patients (N = 535) in the Dry Eye Assessment and Management study with moderate to severe DED completed the Ocular Surface Disease Index on DED symptoms, the SF-36 on quality of life, and the Brief Ocular Discomfort Inventory questionnaire and had a comprehensive ophthalmic assessment by a study-certified clinician. The ocular discomfort on average over the past week was scored on an 11-point scale (0 for no discomfort and 10 for discomfort as bad as you can imagine).

RESULTS

The average ocular discomfort scores for patients ranged from 0 to 10, with a mean of 4.28. Discomfort scores did not vary with demographic characteristics, signs of DED, self-reported depression, or self-reported nonocular pain conditions. Ocular discomfort scores did correlate moderately to strongly with total Ocular Surface Disease Index scores (Spearman correlation coefficient, rs, 0.47-0.67) and with measures of interference with activities of daily living [general activity level, mood, walking ability, ability for normal work, relations with other people, sleep, and enjoyment of life (rs = 0.39-0.65)].

CONCLUSIONS

Among patients in the Dry Eye Assessment and Management study, worse ocular discomfort was associated with worse overall DED symptoms and interfered to a greater degree with activities of daily living. Ocular discomfort is an important part of the assessment of patients with DED.

Patient-Reported Burden of Dry Eye Disease in the United States: Results of an Online Cross-Sectional Survey

PURPOSE

To evaluate functional vision, general health status, and work productivity in individuals with and without dry eye disease (DED).

DESIGN

Cross-sectional study.

METHODS

Setting: General US population (2018).

STUDY POPULATION

Adults ≥18 years with (n = 1003) or without (n = 1006) self-reported DED.

MAIN OUTCOME MEASURES

All respondents completed the National Eye Institute Visual Function Questionnaire (VFQ) and the EuroQol 5-dimensions 5-levels (EQ-5D-5L). All respondents with DED completed the eye dryness score (EDS) visual analogue scale, Ocular Comfort Index (OCI), and Work Productivity and Activity Impairment (WPAI) questionnaire. Half of respondents with DED completed the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire; the other half completed the Dry Eye Questionnaire 5 (DEQ-5) and Standardized Patient Evaluation of Eye Dryness (SPEED), McMonnies, and Symptom Assessment in Dry Eye (SANDE) questionnaires. All analyses were descriptive.

RESULTS

Respondents with DED reported more comorbidities, greater exposure to adverse environmental conditions, and lower (worse) mean (standard deviation) scores on the modified Rasch-scored 28-item VFQ (VFQ-28R) total score (68.8 [11.9] vs 81.2 [12.7]) and EQ-5D-5L (0.82 [0.13] vs 0.88 [0.14]) than respondents without DED. Respondents with DED and EDS ≥60 (highest discomfort) fared worse on OCI, VFQ-28R, and WPAI than respondents with DED and EDS <40 (lowest discomfort). Similar findings were observed with IDEEL, DEQ-5, SPEED, McMonnies, and SANDE scores.

CONCLUSIONS

There is a substantial burden of DED on functional vision, general health status, and productivity; and further, these parameters appear to worsen with increasing EDS.

Comparison on the vision-related quality of life between outpatients and general population with dry eye syndrome

PURPOSE

To compare the impact of dry eye syndrome (DES) on vision-related quality of life (VR-QoL) between outpatients and general populations.

METHODS

This cross-sectional comparative study enrolled 154 participants, 77 outpatients and 77 general participants, all of whom met the diagnostic criteria of DES. Apart from the collection of sociodemographic and clinical data, the Chinese version of 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and Ocular Surface Disease Index Questionnaire (OSDI) were administered. Main outcome measures include the comparison on the OSDI score and VFQ-25 score between two groups, and their correlation with sociodemographic and clinical data.

RESULTS

The two groups were comparable concerning sociodemographic parameters except that the outpatients were better educated (χ(2) = 18.609, p < 0.001). The ophthalmic data related with DES did not have statistically significant differences between two groups except that the proportion of subjects with positive corneal fluorescein staining (CFS) was higher in outpatients (χ(2) = 21.296, p < 0.001). The outpatients reported significantly higher OSDI scores and lower VFQ-25 scores. The VFQ-25 composite score had negative correlation with the OSDI score of all participants or that of outpatients solely (ρ = -0.247 and -0.397, p = 0.030 and 0.000, respectively). Among outpatients, the value of Schirmer test (ST), tear film breakup time (TBUT) and CFS in the eyes with worse DES had significant correlations with the OSDI overall scores, while TBUT and CFS of both eyes correlated with the VFQ-25 composite score.

CONCLUSIONS

DES exerts more adverse impact on VR-QoL in outpatients than general patients. The impairment of VR-QoL has a significant correlation with the severity of DES.

Association between dry eye symptoms and suicidal ideation in a Korean adult population

Purpose

This study assessed the association of dry eyes with depression and suicidal ideation in a Korean adult population.

Methods

Data from 16408 participants (6972 men and 9436 women) aged ≥ 19 years included in the fifth Korea National Health and Nutrition Examination Survey, conducted from 2010–2012, were analyzed. For dry eyes, surveys of previous diagnosis of dry eye disease (DED) by an ophthalmologist and experience of subjective dry eye symptoms were separately used. Diagnosis of depression and suicidal ideation were obtained via responses to an interviewer-assisted questionnaire, and questions were asked in a closed-ended response format. Logistic regression was used to examine the associations between dry eyes, depression, and suicidal ideation.

Results

DED diagnosis exhibited an odds ratio (OR) of 1.32 (95% confidence interval [CI] 1.11–1.57) for depression and 1.24 (95% CI 1.05–1.48) for suicidal ideation compared to those without DED, after adjusting for sex, age, education, occupation, household income, body mass index, smoking behavior, alcohol consumption, physical activity, hypertension, diabetes, dyslipidemia, thyroid diseases, major cardiovascular disease, and cancer. Similarly, the adjusted OR (95% CI) of dry eye symptoms was 1.50 (95% CI 1.30–1.73) for depression and 1.47 (95% CI 1.27–1.70) for suicidal ideation.

Conclusion

Our findings suggest that dry eyes (either DED diagnosis or dry eye symptoms) may be associated with the prevalence of depression and suicidal ideation in the Korean adult population.

Acupuncture for dry eye: a multicentre randomised controlled trial with active comparison intervention (artificial tear drop) using a mixed method approach protocol

BACKGROUND

Previous studies of acupuncture show favourable results for both subjective and objective outcomes of dry eye. However, firm conclusions could not be drawn from these studies because the quality of the trials was too low to establish concrete evidence. Therefore, this study was designed both to avoid the flaws of the existing trials and to assess the effectiveness, cost-effectiveness and qualitative characteristics of acupuncture treatment for dry eye.

METHODS/DESIGN

One hundred fifty participants with dry eye will be recruited into three independent hospitals from different areas: Korea Institute of Oriental Medicine, DongGuk University Ilsan Oriental Hospital and Dongshin University Gwangju Oriental Hospital. The number of participants required was calculated from the data of a previous, relevant study. These patients will be randomly allocated into acupuncture treatment or artificial tear groups. Either 17 acupuncture points (bilateral BL2, GB14, TE 23, Ex1, ST1, GB20, LI4, LI11 and single GV23) will be used 3 times a week or disposable artificial tear drops (Refresh Plus®, ALLERGAN) will be provided for use at least once a day for 4 weeks. The ocular surface disease index (OSDI), tear film break-up time (TFBUT), Schirmer I test, visual analogue scale (VAS) for self-assessment of ocular discomfort, general assessment (by both acupuncture practitioners and participants) and quality of life (QOL) through the Measure Yourself Medical Outcome Profile-2 (MYMOP-2) will be assessed for approximately 3-months for each study participant. In addition, qualitative study and cost-effectiveness of acupuncture treatment will be conducted.

TRIAL REGISTRATION

ClinicalTrials.gov (Identifier: NCT01105221).

[Lack of concordance between dry eye syndrome questionnaires and diagnostic tests]

PURPOSE

To report the prevalence of dry eye syndrome (DES) in a subset of patients > 50 years old in Valladolid, Spain, calculate internal validity of two DES screening questionnaires, and correlate the results with DES diagnostic tests.

METHODS

Patients > 50 years-old were randomly selected from the medical network census in Valladolid; they answered the modified McMonnies questionnaire (Q1) and the Ocular Surface Index questionnaire (Q2) and then underwent an ophthalmic evaluation which included: tear break-up time (TBUT), fluorescein and Rose Bengal staining, and Schirmer with anesthesia were performed. Descriptive analysis, test concordance analysis, and Q1 and Q2 reliability using ROC curves were performed.

RESULTS

A total of 270 subjects (58.2% female; 41.8% male) with an average age of 64.5 years (95% CI: 63.3 - 65.7) were enrolled. The prevalence of DES based on the Schirmer-Tear break-up time tests combination was 24.2%. The mean Q1 score was 1.2, and 1.4 for Q2. Grittiness and discomfort in dry environments (28.9%) were the most common symptoms recorded for Q1. For Q2 "grittiness" (99.2%) and "burning sensation" (98.9%)were the most common symptoms. With the Schirmer-TBUT combination, DES prevalence in Valladolid was 24.2%, 45.8% with TBUT, and 45.6% with Schirmer test. Values for the areas under the ROC curve for Q1, Q2, and most objective tests were < 0.5, except for Q2 and TBUT (0.503). Cronbach alpha was > 0.7 for all Q1 and Q2 items. Statistically significant concordance was reported for Schirmer - TBUT (κ=0.14) and TBUT- fluorescein staining (κ=0.09); (P<0.05).

CONCLUSIONS

Q1 and Q2 were unreliable for DES diagnosis and showed poor internal consistency. Fluorescein and Rose Bengal staining were the most concordant tests for DES diagnosis. Finally, there was no correlation between either screening questionnaire and objective DES diagnostic tests.

Sleep and subjective happiness between the ages 40 and 59 in relation to presbyopia and dry eye

Purpose

The aim of this study was to explore the status of quality of life between the ages 40–59 in relation to presbyopia and dry eye.

Methods

Near add power and preferred contact lens power were examined in 219 participants at three clinics. 2000 participants completed a web-based survey on presbyopic symptoms, symptomatic dry eye, sleep quality, and subjective happiness.

Results

Mean preferred corrected visual acuity was less than 20/20 in women (vs men, P<0.01) who were more often prescribed under-corrected contact lenses, whereas men preferred full correction. According to the annual progression rate of near add power in men (0.1468D/year), the estimated difference in presbyopia progression between men and women was 0.75 years in the right eye, and 1.69 years in the left eye, implying men might suffer presbyopia earlier than women due to higher myopic power of daily use contact lenses. The web-based survey revealed that men reported lower subjective happiness than women (P<0.001) and earlier onset of presbyopic symptoms by 1.1–1.7 years (P<0.05). Men received their first reading glasses 0.8 years earlier than women (P = 0.066). Multiple regression analysis demonstrated that awareness of presbyopic symptoms, visual burden, and dry eyes were significantly correlated with poor sleep quality and subjective happiness.

Conclusion

Presbyopia and dry eye were significantly associated with sleep quality and subjective happiness in middle-adulthood.

Lacrimal plugs as a therapy for contact lens intolerance

We investigated whether canalicular occlusion with a lacrimal plug could increase objective and/or subjective comfort in contact lens (CL) wearers (n = 9) with both a history of lens intolerance and relative tear fluid deficiency. A modified Schirmer test (MST) was performed with the lids closed and under topical anaesthesia. Patients with values of < or = 10 mm/5 min were included. The plugs were inserted into the inferior canaliculus of the eye with the lower MST result; the contralateral eye served as a control. Conjunctival hyperaemia, Rose-Bengal and fluorescein scores, as well as subjective irritation, decreased significantly in plugged eyes at the 1 month follow-up visit but had returned to the pre-operative level at the 3 month visit. Tear fluid plasmin activity was elevated prior to plug insertion. Plasmin activity of the plugged eye was significantly lower at the 1 month visit but neither tear fluid flow (in the collection capillary) nor plasmin release showed any changes. The mean MST value improved significantly, whereas conjunctival chemosis and limbal hyperaemia showed no improvement at the 1 or 3 month follow-up visits after inferior punctual occlusion. Occlusion of the lower canaliculus with a lacrimal plug seems to induce a relatively short-lasting subjective and objective benefit for CL wearers. Plug escape or adaptive changes in lacrimal fluid secretion/elimination rate probably took place during the follow-up. The association of increased plasmin activity with tear deficiency might lead to enhanced tissue proteolysis, and thus contribute to CL-related ocular surface changes.

Preservatives and ocular surface disease: A review

Ocular surface disease (OSD) is a complex condition that can cause a range of symptoms (e.g, dryness, irritation, and pain) and can significantly impact the quality of life of affected individuals. Iatrogenic OSD, a common finding in patients with glaucoma who receive chronic therapy with topical ocular antihypertensive drugs containing preservatives such as benzalkonium chloride (BAK), has been linked to damage to the ocular surface barrier, corneal epithelial cells, nerves, conjunctival goblet cells, and trabecular meshwork. Chronic BAK exposure activates inflammatory pathways and worsens symptoms, compromising the success of subsequent filtration surgery in an exposure-dependent manner. In eyes being treated for glaucoma, symptomatic treatment of OSD may provide some relief, but addressing the root cause of the OSD often necessitates reducing or, ideally, eliminating BAK toxicity. Strategies to decrease BAK exposure in patients with glaucoma encompass the use of preservative-free formulations or drugs with alternative and less toxic preservatives such as SofZia®, Polyquad, potassium sorbate, or Purite®. Though the benefits of these alternative preservatives are largely unproven, they might be considered when financial constraints prevent the use of preservative-free versions. For patients receiving multiple topical preserved drugs, the best practice is to switch to nonpreserved equivalents wherever feasible, regardless of OSD severity. Furthermore, nonpharmacological approaches, including laser or incisional procedures, should be considered. This review explores the effects of BAK on the ocular surface and reviews strategies for minimizing or eliminating BAK exposure in patients with glaucoma in order to significantly improve their quality of life and prevent complications associated with chronic exposure to BAK.

Relationship Between Dry Eye Disease and Emotional Disorder: The Mediating Effect of Health Anxiety

Objective

This study aims to investigate the relationship between dry eye disease (DED) and anxiety, as well as DED and depression. Additionally, the influence of health anxiety (HA) on this relationship was determined.

Methods

A total of 206 patients with DED were recruited from Tianjin Medical University Eye Hospital clinic and surveyed using demographic questionnaires, the Ocular Surface Disease Index (OSDI), Hospital Anxiety and Depression Scale (HADS), and Short Health Anxiety Inventory (SHAI). Additionally, they were examined using Keratograph 5M and assessed for DED by corneal fluorescein staining. Regression analysis and the bootstrap method were used to investigate the influence of HA on the relationship between DED and emotional disorders.

Results

Among the 206 patients with DED, 52 (25.24%) and 56 (27.18%) patients showed depression and anxiety, respectively. The OSDI score and HA were positively correlated with depression and anxiety (P &lt; 0.01). The direct effects of OSDI on depression and anxiety were significant (95% confidence interval [CI]: 0.017–0.069; 0.008–0.060). Additionally, the bootstrap test showed significant mediating effects of HA (95% CI: 0.001–0.016; 0.003–0.021). The results suggested that the severity of DED symptoms, as measured by the OSDI score, affected anxiety and depression by a direct and an indirect pathway mediated by HA.

Conclusions

We found a significant correlation between DED and anxiety and depression. Moreover, HA was a mediator of the relationship between DED symptoms and anxiety and depression.

Exploring the Prevalence of Dry Eye Disease and Its Impact on Quality of Life in Saudi Adults: A Cross-Sectional Investigation

Background and Objectives: Dry eye disease (DED) is a multifactorial condition that affects quality of life (QoL). Symptoms like discomfort, blurred vision, and light sensitivity can negatively impact work efficiency, productivity, and psychological well-being. This study aimed to examine the relationship between DED and QoL, identify risk factors, and estimate DED prevalence in Saudi Arabia. Materials and Methods: This cross-sectional study included 1062 participants from Saudi Arabia, recruited via convenience sampling. Data were collected using an online questionnaire with three sections: sociodemographic information, the ocular surface disease index (OSDI) to assess DED severity, and the Arabic WHOQOL-BREF questionnaire to evaluate QoL. Results: Among participants, 77% suffered from DED. Males (β = -9.18, p < 0.001), postgraduate degree holders (β = -13.86, p = 0.001), and individuals with income >15,000 SR (β = -5.10, p = 0.023) had lower OSDI scores compared to reference groups (females, those with high school education or lower, and those with income <5000 SR, respectively), indicating a lower DED risk. Employed individuals, students (employed: β = 10.78, p < 0.020; students: β = 10.60, p < 0.016), divorced/widowed individuals (β = 18.70, p < 0.003), and those with diabetes, hypertension, and thyroid disorders showed higher OSDI scores. Higher OSDI scores correlated with lower QoL scores across all domains (physical: β = -0.26, p < 0.001; psychological: β = -0.22, p < 0.001; social: β = -0.25, p < 0.001; environmental: β = -0.20, p < 0.001). Conclusions: DED significantly affects all QoL domains. Risk factors include occupation, diabetes, hypertension, and thyroid disorders. Awareness and prevention efforts should be prioritized by institutions, while physicians should screen for DED in patients with chronic conditions. Further research is needed on the long-term effects of these risk factors and to improve management strategies.

An Investigation of the Psychosocial Outcomes of Dry Eye Disease Treatment in Children with Computer Vision Syndrome

Objectives

Computer vision syndrome (CVS) is a common disorder among children and is often associated with dry eye disease (DED). While researchers have shown a higher prevalence of psychopathology in older patients with DED, the impact of CVS-induced DED on the psychological state of children is not well known. This study aimed to evaluate psychological outcomes before and after DED treatment in pediatric patients with CVS-related DED.

Materials and Methods

In this study, a total of 38 children (32 girls, 6 boys) with CVS-related DED were evaluated with the Schirmer test, tear break-up time (TBUT), ocular surface disease index (OSDI), and Oxford grading scale at the time of diagnosis and after treatment with artificial tear drops. Additionally, quality of life (QoL) and anxiety and depression symptoms were assessed using self-report scales for children.

Results

The mean age and mean daily screen exposure of the patients were 13.95±2.42 years and 5.65±2.31 hours, respectively. After treatment, TBUT and Schirmer test values of the patients increased significantly, while OSDI values decreased (p<0.001 for all). The anxiety and depression scores of the patients decreased, while QoL functionality scores increased (p<0.05 for all) following treatment. There were significant correlations between Schirmer test values and anxiety scores (r=-0.32, p=0.045) and QoL total scores (r=0.38, p=0.016).

Conclusion

Enhanced QoL and decreased anxiety and depression scores were associated with improved Schirmer test results, indicating that appropriate DED treatment may mitigate the psychosocial effects of CVS-related DED in pediatric patients.

Post-COVID-19 dry eye negatively impacts the patient's quality of life

PURPOSE

To describe the ophthalmological findings of dry eye disease and its relation to the quality of life of COVID-19 survivors.

METHODS

COVID-19 survivors who had previously been hospitalized at Hospital das Clínicas de Ribeirão Preto complex underwent an ophthalmological evaluation, which included a dry eye disease questionnaire, break-up time, fluorescein staining, and Schirmer test. We collected the presenting and best-corrected visual acuity, sociodemographic data, personal medical history, and scores from a self-reported quality of life questionnaire (WHOQOL-bref). According to the severity of the acute phase of the disease, the patients were classified into mild-to-moderate, severe, and critical groups.

RESULTS

Ninety-five patients (190 eyes) were evaluated 100 ± 44 days after the onset of COVID-19 symptoms. Of these, 83 patients (87.3%) completed the WHOQOL-bref questionnaire. Ten patients (12.0%) had mild-to-moderate COVID-19, 41 (49.4%) had severe COVID-19, and 32 (38.6%) had critical COVID-19. The median best-corrected visual acuity was logMAR 0 (0-1). Approximately 26.3% patients had a history of dry eye disease or severe dry eye symptoms (frequent or constant ocular dryness and irritation). There was an association between the proportion of patients with dry eye disease and the quality of life (p=0.014) and health (p=0.001). Furthermore, there was a significant trend between the proportion of patients with dry eye disease and how they rated their health and quality of life (p=0.0004 and 0.0027, respectively.

CONCLUSIONS

There is a significant negative correlation between the proportion of patients with dry eye disease and their self-reported quality of life.

Perspectives of dry eye patients in the United Kingdom on risk factors and desired treatment outcomes

PURPOSE

Successful management of dry eye disease depends upon an effective two-way communication between eyecare practitioners and affected patients. However, there has been limited investigation into the perspectives of patients with dry eye disease in the United Kingdom regarding their risk factors and desired treatment outcomes.

METHODS

An online, self-administered, anonymous survey was distributed to patients based in the United Kingdom who have had a diagnosis of dry eye disease between November 2023 to March 2024. The survey consisted of four main sections including demographics, the 5-item Dry Eye Questionnaire (DEQ-5), and Likert scales rating the likelihood of various risk factors contributing to their dry eyes and the desired treatment outcomes in various components of signs and symptoms.

RESULTS

The survey was completed by 152 respondents (mean age 51.7 ± 16.7 years, 103 females). Respondents rated environmental conditions the highest in terms of likelihood of contributing to their dry eye disease [median (interquartile range): 7.5 (5-10)], followed by digital device use [7 (4-9)] and poor sleep quality [4 (1-7)]. In terms of desired treatment outcomes, symptom frequency and severity as well as tear stability were ranked the highest in importance [10 (8-10)].

CONCLUSIONS

This survey demonstrated the perceptions of dry eye patients in the United Kingdom regarding lifestyle or modifiable risk factors contributing to their dry eye disease, as well as the most important treatment outcomes of these patients. These aspects should be considered by clinicians in the management of dry eye disease, as well as researchers particularly when designing studies which investigate treatment effects of current and novel dry eye interventions.

Dry eye disease adverse reaction of pharmacological treatment for early-stage breast cancer

Breast cancer is the most prevalent cancer worldwide. With advancements in breast cancer diagnosis and treatment, the prognosis of patients with early-stage cancer has significantly improved. Enhancing the long-term quality of life of patients after antineoplastic therapy, including visual quality, has become a crucial research focus. This review aims to comprehensively summarize dry eye disease adverse reaction resulting from pharmacotherapy for early-stage breast cancer. Through a review of the relevant literature, this study explored the etiology, clinical features, and potential therapeutic strategies for drug-induced dry eye disease in breast cancer treatment. A thorough understanding of the medication-induced dry eye disease adverse reaction aid clinicians in monitoring and managing patients' ocular health more effectively, facilitating early diagnosis and intervention, preventing complications, and ensuring optimal visual protection for patients undergoing breast cancer treatment.

Comparing Patients' Perceptions of Dry Eye Disease Between Spanish- and English-Speaking Patients in the United States

PURPOSE

It is well-known that patients' perceptions of their disease can impact management strategies and disease outcomes. Limited knowledge exists on such perceptions in dry eye disease (DED) and the role of language in these perceptions. Herein, we compared the perceptions about DED between Spanish- and English-speaking patients.

METHODS

This cross-sectional study included 146 patients with DED who underwent ophthalmic evaluation and completed questionnaires assessing their perceptions of DED on a 10-point scale during their routine appointments. Perceptions included opinions on the level of satisfaction with understanding of DED, ease of following doctor's advice, effectiveness of treatment, satisfaction with DED care, and outlook on DED. Perceptions were categorized as low (scores 0-2), moderate (scores 3-7), and high (scores 8-10). The percentage of patients with high perception scores were then compared between Spanish- and English-speaking patients.

RESULTS

There were 48 Spanish speakers and 98 English speakers. Overall, high scores of DED perceptions were identified in 47.9% for satisfaction with the level of understanding of DED, 72.6% for ease of following doctor's advice, 52.1% for helpfulness of DED treatment, 64.4% for satisfaction with DED care, and 52.1% for optimistic outlook on DED. High scores for satisfaction with the level of understanding of DED were significantly lower in Spanish speakers (27.1%) than English speakers (58.2%, p < .001). No significant differences were observed in other perceptions between Spanish- and English-speaking participants.

CONCLUSIONS

Spanish-speaking subjects reported lower satisfaction with their understanding of DED than English speakers. Clinicians should provide health services and educational materials in the patient's preferred language to minimize barriers to understanding their disease.

Dry eye in mind: Exploring the relationship between sleep and ocular surface diseases

PURPOSE

Dry Eye Disease (DED) is regarded as the most common ocular surface disease worldwide, entailing symptoms that have a major impact on the physical and psychological well-being of DED patients. In this context, the impact of sleep quality on DED has recently attracted attention. Indeed, although little is known about the mechanisms underlying the relationship between sleep and ocular surface diseases, recent evidence suggests that a reciprocal relationship exists between sleep quality and DED. Aim of the study was to investigate such relationship by means of both survey-based and instrumental analysis in a large population.

PATIENTS AND METHODS

The present cross-sectional study included 1182 DED patients who completed the Insomnia Severity Index (ISI) and the Ocular Surface Disease Index (OSDI) questionnaires. Moreover, tear break-up time (TBUT) and ocular surface staining (OSS) data of included patients were collected by physicians.

RESULTS

According to the findings of this study, in DED patients, the severity of dry eye symptoms and signs, assessed by OSDI score, TBUT, and ocular surface staining, is associated with more severe insomnia symptoms. Furthermore, higher severity of DED symptoms seems to be associated with the occurrence of nocturnal awakenings rather than with problems in falling asleep.

CONCLUSIONS

Present work contributes to the understanding of the complex relationship between DED and insomnia by showing that in a large population of DED patients, the more severe the insomnia, the more severe the DED symptoms and signs.